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One breath at a time: living with cystic fibrosis.

The purpose of this qualitative investigation was to describe the lived experiences of families caring for a child with cystic fibrosis at the time of initial diagnosis. Phenomenological research methodology as described by Colaizzi (1978) was used to guide the investigation. A purposive sample of 9 family members voluntarily participated in the study. Data were gathered through focus groups and written narratives. Data analysis yielded 3 essential theme clusters with subthemes: Falling Apart, Pulling Together, and Moving Beyond. Within the theme of Falling Apart, the subthemes of Devastation of Diagnosis, An All-Encompassing Sense of Fear and Isolation, and An Overwhelming Sense of Guilt and Powerlessness are described. The theme of Pulling Together included the subthemes of Perpetual Vigilance and Returning to Normalcy, and the third theme of Moving Beyond included the subtheme of An Optimal Unfolding of a New Kind of Consciousness. This article describes in detail the themes and subthemes identified during data analysis and the fluid nature of the relationship that exists within the essential structure of caring for a family member with cystic fibrosis. The diagnosis of cystic fibrosis most often comes as a life-shattering experience to families. Lifestyle readjustments are made in an attempt to return to some sense of family normalcy. In order to achieve stability in their daily lives, families are vigilant in the care and monitoring of the health of a child with cystic fibrosis. Ongoing support from health care professionals that is grounded in the realities of living with cystic fibrosis is critical. This study describes how families develop their own unique way of controlling the experience of living with cystic fibrosis, one day and one breath at a time.

Adaptation, Psychological↗

Drug absorption from inhalation aerosols administered by positive-pressure ventilation. I: Administration of a characterized, solid disodium fluorescein aerosol under a controlled respiratory regime to the beagle dog.

An apparatus and novel method is described for administration of well-characterized inhalation aerosols, under strictly controlled respiratory regimes, direct to the respiratory tract (RT) of the beagle dog by positive-pressure ventilation. The method enables the study of systemic absorption kinetics of compounds delivered as inhalation aerosols as a function of the aerosol particle size and respiratory variables provided their intrinsic pharmacokinetics are linear. Aerosol characteristics are determined by sampling the aerosol at a point close to its entry to the endotracheally intubated animal. The chosen positive-pressure ventilatory regime, which is monitored as airway pressure and exhaled volume versus time, can be held constant for the aerosol administration period. The methodology is illustrated by administration of a solid polydispersed aerosol of disodium fluorescein. Resultant plasma concentrations (C) were determined as a function of time by sampling from an indwelling venous cannula. The pharmacokinetic analysis of resultant C versus time data, together with that from an intravenous control experiment, is described to determine the amount absorbed as a function of time. Following aerosol administration according to the chosen respiratory regime, fluorescein was rapidly absorbed from the RT. The methodology will enable systematic variation of the particle size and positive-pressure respiratory regime in order to determine effects on drug absorption kinetics.

Absorption↗

Perspectives of people with enduring mental ill health from a community-based qualitative study.

BACKGROUND: The views of people with enduring mental ill health have received limited exploration. Existing work has largely focused on patients in specialist mental health settings, rather than on a wider range of patients in the community. AIM: To explore experiences and perceptions of health care of people with enduring mental ill health. DESIGN OF STUDY: A community-based qualitative study using theoretical sampling, in-depth interviews, and grounded methodology. SETTING: A total of 34 responders registered with four general practices, serving five wards with a mean Townsend Deprivation Score of 7.75. METHOD: Subjects were chosen using a theoretical sampling framework and they participated in one-to-one interviews which were audiotaped. Themes were identified and developed by reading transcripts, then they were further refined and classified manually by open coding into key categories using a grounded approach. RESULTS: The primary goal of the responders was to enhance, sustain, and take control of their mental health. The building of positive therapeutic relationships with professionals based upon effective communication, trust, and continuity were important to achieving this aim. However, the settings in which their health care took place could affect responders' attempts to deal with social stigma. Experiences of social isolation, socioeconomic privation, and stigmatisation were often pervasive. These compromised responders' opportunities and their capacity to enhance their mental health, compounding their illness and marginalisation. CONCLUSIONS: This study shows the potential of health professionals to empower people with enduring mental ill health, by attending to the quality of communication and continuity of care they provide and to where this takes place. It further underlines a need to address the social stigma and exclusion this group experiences.

Adult↗

[Ambulatory occupational therapy. Results of a multicenter, prospective evaluation study].

Work is an indispensable component in the treatment of (chronically) mentally ill patients. In critically scientific terms, however, there is no adequate proof of its therapeutic effectiveness. Efforts at evaluation fail because of the complexity of the clinical reality. Moreover, the differential aspects of the indication have been ignored in research. This is exemplary of the problems confronting research on the provision of psychiatric treatment: the status of what has been put to the test and introduced on the basis of routine experience is such that emperical investigations are not carried out because of lack of interest and methodological problems. Against the background of this dilemma, this study seeks a middle course for measuring success. We carried out a prospective study on a representative sample of 126 outpatients in 7 clinical work therapy departments. The results show that outpatient work therapy can be seen as a useful part of differentiated therapy, in particular for chronically mentally ill patients. Previous experience is summed up in a review of the literature.

Activities of Daily Living↗

Myocardial fiber orientation mapping using reduced encoding diffusion tensor imaging.

A precise knowledge of the myocardial fiber architecture is essential to accurately understand and interpret cardiac electrical and mechanical functions. Diffusion tensor imaging has been used to noninvasively and quantitatively characterize myocardial fiber orientations. However, because the approach necessitates diffusion to be measured in multiple encoding directions and frequently at multiple weighting levels, the required data set size may present a limitation on its acquisition time efficiency. Applying the principles of reduced encoding imaging (REI), four basic reconstruction schemes, keyhole using direct substitution, keyhole with baseline correction, symmetrically encoded REI with generalized-series reconstruction (RIGR), and asymmetrically encoded RIGR, are evaluated in terms of their accuracy in diffusion tensorfiber orientation mapping of excised myocardial samples. Results show that the performances of all REI schemes, at approximately 50% reduced encoding, are at least comparable with that of a control experiment consisting of proportionally reduced number of full k-space images. Moreover, although performances of the symmetrically and asymmetrically encoded RIGR schemes are similar, both methods provide significant improvements over the control experiment and the direct-substitution keyhole technique. These findings demonstrate the potential of the general REI methodology for diffusion tensor imaging and pave the way for modified schemes involving rapid imaging sequences or alternative k-space sampling strategies to achieve even better data acquisition time efficiency and performance.

Analysis of Variance↗

Progressing evidence-based practice: an effective nursing model?

AIMS: This paper presents findings from telephone interviews completed with link nurses 2 years into the project to explore how participation progressed achievement of evidence-based practice where the link nurses worked. BACKGROUND: In 2001, an innovative practice development initiative was launched in Scotland. A national network of experienced nurses from across the country was recruited to form the inaugural Community of Practice. This involved describing gerontological nursing, pioneering a nurse-sensitive methodology to craft care guidance that reflects the agreed practice model, and constructing a virtual college based on a situated learning model. METHODS: A volunteer sample of link nurses took part in telephone interviews exploring experiences of using the virtual college and the extent to which the description of gerontological nursing and the first best practice statement on nutrition had influenced practice. FINDINGS: Five components (themes) were identified as facilitating the attainment of evidence-based practice. These focussed on confidence-building and the positive benefits of achieving vision and clarity for gerontological nursing. Membership of a national Community of Practice afforded status and strengthened sense of professional identity. The inclusive knowledge synthesis methodology used to prepare, pilot and support implementation of the best practice statement was highly valued. Progress towards evidence-based practice in all affiliated areas was reported. Major challenges for nurses in participating in the virtual college included the absence of a learning-at-work culture, lack of time and doubts about the legitimacy of internet-based learning. CONCLUSION: The evaluation indicates the potential merits of e-practice development, particularly for nurses who feel geographically and professionally isolated or disenchanted with available continuing professional development opportunities. Participation in the virtual college appeared to enrich practice and foster a culture of change.

Aged↗

[Non-invasive recording of late ventricular potentials--methodology and first clinical experiences (author's transl)].

Late potentials occurring after the QRS complex were searched for from the body surface using high-gain amplification and signal-averaging techniques with filter settings between 100 and 300 hz at a sampling rate of 10 khz. The number of repetitions of the averaging process ranged between 150 and 300. 52 patients were studied. In 11 control subjects, no late potentials were detected within the ST segment. Late potentials were observed in 3/27 patients without previously documented ventricular tachycardia, all having left ventricular aneurysms. All three patients had evidence of increased ventricular vulnerability (one dying from ventricular tachycardia, one with stimulus-inducible ventricular tachycardia, one with multiple episodes of ventricular fibrillation after surgery). In patients with previously documented ventricular tachycardia and/or fibrillation, late potentials occurred in 7/14 cases (50%), mainly in those with aneurysms (6/8 pts = 75%). Mean onset of late potentials after the QRS complex was 38 +/- 20.1 ms, mean amplitude was 3.9 +/- 2.0 uV, and mean duration was 17.1 +/- 5.4 ms. We conclude that late potentials, which represent late depolarization of a mass of ventricular tissue after slow conduction, herald increased susceptibility to ventricular tachycardia mainly in patients with ventricular aneurysms.

Adult↗

Species-specificity and sensitivity of a PCR-based assay for Perkinsus marinus in the eastern oyster, Crassostrea virginica: a comparison with the fluid thioglycollate assay.

We examined the species-specificity and sensitivity of a polymerase chain reaction (PCR)-based assay for Perkinsus marinus and compared its overall performance with the fluid thioglycollate medium (FTM) assay on oyster (Crassostrea virginica) hemolymph, mantle, and rectum samples. Our results indicated that the PCR-based methodology is species-specific because Perkinsus olseni, Perkinsus atlanticus, and Perkinsus spp. DNAs were not amplified with the PCR primers developed for P. marinus diagnosis. The sensitivity of the PCR method, as assessed through spike/recovery experiments, was established by the detection of as few as 1 cell of P. marinus in 30 mg of oyster tissue. Tissue samples from naturally infected oysters analyzed both by the FTM and PCR assay suggested that the latter was more sensitive for the diagnosis of P. marinus. Positive results for P. marinus infection ranged from 70% to 83% by FTM and from 92% to 100% by PCR, depending on the tissue examined. Therefore, species-specificity and sensitivity of the NTS-based PCR assay validate its use as a tool for assessment of P. marinus in mollusks.

Animals↗

Harmaline-induced tremor as a potential preclinical screening method for essential tremor medications.

No preclinical method to evaluate potential new medications for essential tremor (ET) is available currently. Although harmaline tremor is a well known animal model of ET, it has not found utility as a preclinical drug screen and has not been validated with anti-ET medications. We measured harmaline tremor in rats (10 mg/kg s.c.) and mice (20 mg/kg s.c.) with a load sensor under the cage floor and performed spectral analysis on 20-minute epochs. The motion power over the tremor frequency bandwidth (8-12 Hz in rats; 10-16 Hz in mice) was divided by the motion power over the full motion frequency range (0-15 Hz in rats; 0-34 Hz in mice). The use of these measures greatly reduced data variability, permitting experiments with small sample sizes. Three drugs that suppress ET (propranolol, ethanol, and octanol) all significantly suppressed harmaline-induced tremor. We propose that, with this methodology, harmaline-induced tremor may be useful as a preclinical method to identify potential medications for ET.

Animals↗

Do Medicaid physician fees for prenatal services affect birth outcomes?

This study exploits a natural experiment to examine the relationship between Medicaid physician fees and birth outcomes among a national sample of pregnant women. Applying a cohort difference-in-differences methodology, I find a significant negative association between these fees and the risk of low birth weight. I estimate that a 10% higher than average relative Medicaid fee is independently associated with a 0.074% lower absolute risk of low birth weight (<2.5 kg) and a 0.035% lower risk of very low birth weight (<1.5kg) among Medicaid-insured women. For low-income women, this association grows significantly. Lastly, I find a moderate association between these fees and use of first trimester prenatal services.

Cost-Benefit Analysis↗

4-MTA: a new synthetic drug on the dance scene.

4-MTA (p-methylthioamphetamine) is a new synthetic sulphur derivative of amphetamine that has been associated with six deaths since it was first identified in Europe in 1997. Sold as 'ecstasy' or 'Flatliners', the drug like MDMA is a potent serotonin releaser. Using a self-nominated sampling methodology we accessed over 1000 dance drug users through a magazine survey. Ten percent of respondents thought that they had used 4-MTA. Those with experience of 4-MTA tended to come from a sub-population of heavy 'ecstasy'-users. Responses to the effects of the drug were mixed, although about a quarter of those who believed that they had tried 4-MTA thought that they would use it again.

Adolescent↗

A new approach for the analysis of bacterial microarray-based Comparative Genomic Hybridization: insights from an empirical study.

BACKGROUND: Microarray-based Comparative Genomic Hybridization (M-CGH) has been used to characterize the extensive intraspecies genetic diversity found in bacteria at the whole-genome level. Although conventional microarray analytical procedures have proved adequate in handling M-CGH data, data interpretation using these methods is based on a continuous character model in which gene divergence and gene absence form a spectrum of decreasing gene conservation levels. However, whereas gene divergence may yet be accompanied by retention in gene function, gene absence invariably leads to loss of function. This distinction, if ignored, leads to a loss in the information to be gained from M-CGH data. We present here results from experiments in which two genome-sequenced strains of C. jejuni were compared against each other using M-CGH. Because the gene content of both strains was known a priori, we were able to closely examine the effects of sequence divergence and gene absence on M-CGH data in order to define analytical parameters for M-CGH data interpretation. This would facilitate the examination of the relative effects of sequence divergence or gene absence in comparative genomics analyses of multiple strains of any species for which genome sequence data and a DNA microarray are available. RESULTS: As a first step towards improving the analysis of M-CGH data, we estimated the degree of experimental error in a series of experiments in which identical samples were compared against each other by M-CGH. This variance estimate was used to validate a Log Ratio-based methodology for identification of outliers in M-CGH data. We compared two genome strains by M-CGH to examine the effect of probe/target identity on the Log Ratios of signal intensities using prior knowledge of gene divergence and gene absence to establish Log Ratio thresholds for the identification of absent and conserved genes. CONCLUSION: The results from this empirical study validate the Log Ratio thresholds that have been used in other studies to establish gene divergence/absence. Moreover, the analytical framework presented here enhances the information content derived from M-CGH data by shifting the focus from divergent/absent gene detection to accurate detection of conserved and absent genes. This approach closely aligns the technical limitations of M-CGH analysis with practical limitations on the biological interpretation of comparative genomics data.

Campylobacter jejuni↗

[Breast feeding: assuming risks or guaranteeing benefits].

The development of several action of promotion of the breastfeeding seems do not reach many of the variables that determinate the breastfeeding course. With the proposal of understanding what makes the woman decide about breastfeeding or wearing, this study was developed trying to get the conscious meaning of the breastfeeding experience for the woman, how the importance of the breastfeeding is shown by the woman's action and develop a theoretical sample that represents the experience of breastfeeding for the woman. Based on the theoretical presupposition of the Symbolic Interactionism and taking the Grounded Theory as the methodology, we described the breastfeeding based on the woman's point of view. The research shows that the woman experiences the breastfeeding from a process that evaluates and gives value to it, and that is understood by the themes: Evaluating the capability of breastfeeding, Evaluating the woman's feeling and Taking Decisions which the central phenomenon, representative of the process, is called WEIGHING THE RISKS AND BENEFITS. This study shows that the elements that give the policies for the breastfeeding result from the relation between the action of breastfeeding and several significant symbols shown in the interactive situations experienced by the woman.

Breast Feeding↗

The evaluation of the National Long Term Care Demonstration. 2. Estimation methodology.

Channeling effects were estimated by comparing the post-application experience of the treatment and control groups using multiple regression. A variety of potential threats to the validity of the results, including sample composition issues, data issues, and estimation issues, were identified and assessed. Of all the potential problems examined, the only one determined to be likely to cause widespread distortion of program impact estimates was noncomparability of the baseline data. To avoid this distortion, baseline variables judged to be noncomparably measured were excluded from use as control variables in the regression equation. (Where they existed, screen counterparts to these noncomparable baseline variables were used as substitutes.) All of the other potential problems with the sample, data, or regression estimation approach were found to have little or no actual effect on impact estimates or their interpretation. Broad implementation of special procedures, therefore, was not necessary. The study did find that, because of the frequent use of proxy respondents, the estimated effects of channeling on clients' well-being actually may reflect impacts on the well-being of the informal caregiver rather than the client. This and other isolated cases in which there was some evidence of a potential problem for specific outcome variables were identified and examined in detail in technical reports dealing with those outcomes. Where appropriate, alternative estimates were presented.

Activities of Daily Living↗

Environmental specimen banking. A complement to environmental monitoring.

The risk of environmental damage from the countless chemicals and chemical combinations is estimated by monitoring the air, water, soil, and biota and comparing the findings to known risks. Environmental monitoring involves the collection and chemical analysis of selected samples to determine pollutant trends, forecast damage to the environment, and develop control strategies. However, past experience has taught us that there is always a level of uncertainty associated with the chemical analysis of complex environmental samples. This uncertainty arises from insufficient analytical sensitivity to detect trace levels of damaging pollutants, unsuspected analytical inaccuracies associated with unknown interferences, and limited resolution to identify and quantify all pollutants of interest. Environmental specimen banking can serve as a complement to environmental monitoring by allowing future chemists to analyze preserved samples retrospectively with emerging analytical methodologies. In other words, specimen banking will give later environmentalists the opportunity to characterize chemicals whose hazards were not recognized or for which sufficiently accurate analytical methods were not available. This will enable us to determine whether a newly recognized pollutant is truly a new environmental threat or whether it has always been with us. Although environmental specimen banking is still in its infancy, we now have many experiences that clearly demonstrate that valuable information can be produced. In all environmental monitoring programs, some consideration should be given to preserving selected samples. Ideally, specimen banking will involve; (1) a stable funding commitment, (2) a cryogenic storage facility, (3) development of selection criteria to collect the most valuable environmental specimens, and (4) a continuing research program to develop optimal procedures for collecting, handling, and preserving specimens.

Animals↗

Managing patient discharge to home: the challenges of achieving quality of care.

Discharging older patients from hospital to care at home presents considerable challenges for those concerned about the current mandate of quality management. A great many professionals with different priorities and organizational commitments are involved. The policies and procedures of at least two agencies, a hospital and a home care agency, play a role in shaping the whole process. The purpose of this study was to explore and describe factors other than medical condition and treatment which shaped the quality of the discharge experiences of older patients. Qualitative research methodology was used to document the discharge process from the perspective of 12 rural and nine urban patients, and a purposeful sample of 22 family caregivers and 117 professionals involved in their care. As well, 24 agency administrators with an overview of related policies and procedures provided data. Findings provide an in-depth description of the different implementation approaches and related quality issues in rural and urban settings. Quality management was undermined by role confusion, compromised and overly zealous pursuit of efficiency, fragmented work, variable physician practice style, and communication and coordination problems. Several readily implemented solutions to these problems are recommended. The implications of the more difficult leadership challenges related to achieving reasonable efficiency and maintaining a humane orientation in the complex care system are addressed.

Aged↗

Health promotion in active-duty military women with children.

The purpose of this study was to determine the extent to which selected demographic characteristics, definition of health, perceived health status, perceived self-efficacy, and resources are related to the health promoting behaviors of active-duty women with children and to describe qualitatively the experience of being an active-duty mother. Grounded in Pender's (1996) Health Promotion Model, this study used methodological triangulation to test a hypothesized model. A sample of 141 active-duty women with children using military health services participated. Resource availability and commitment were key components of being successful at balancing home and work demands.

Adult↗

Surveillance for selected maternal behaviors and experiences before, during, and after pregnancy. Pregnancy Risk Assessment Monitoring System (PRAMS), 2000.

PROBLEM/CONDITION: Various maternal behaviors and experiences are associated with adverse health outcomes for both the mother and the infant. These behaviors and experiences can occur before pregnancy (e.g., insufficient intake of folic acid), during pregnancy (e.g., complications requiring hospitalization, such as high blood pressure), and after pregnancy (e.g., inadequate follow-up of infants who were discharged early). Information regarding maternal behaviors and experiences is needed to monitor trends, to enhance the understanding of the relations between behaviors and health outcomes, to plan and evaluate programs, to direct policy decisions, and to monitor progress toward Healthy People 2010 objectives (US Department of Health and Human Services. Healthy People 2010. 2nd. ed. With understanding and improving health and objectives for improving health [2 vols.]. Washington DC: US Department of Health and Human Services, 2000). REPORTING PERIOD COVERED: This report covers data for 2000. DESCRIPTION OF SYSTEM: The Pregnancy Risk Assessment Monitoring System (PRAMS) is an ongoing, state- and population-based surveillance system designed to monitor selected self-reported maternal behaviors and experiences that occur before, during, and after pregnancy among women who deliver a live-born infant in 31 states and New York City. PRAMS employs a mixed-mode data collection methodology; as many as three self-administered surveys are mailed to a sample of mothers, and nonresponders are followed up with a telephone interview. Self-reported survey data are linked to selected birth certificate data and weighted for sample design, nonresponse, and noncoverage to create annual PRAMS analysis data sets. PRAMS data can be used to produce statewide estimates of various perinatal health behaviors and experiences among women delivering a live infant. Four indicators for the year 2000 (multivitamin use, pregnancy-related complications, infant checkup, and postpartum contraceptive use) from 19 states are examined in this report. RESULTS: In 2000, the prevalence of multivitamin use > or =4 times per week in the month before pregnancy ranged from 25.0% to 40.7% across the 19 states. Prevalence of pregnancy-related complications requiring hospitalization ranged from 8.8% to 16.3%. Prevalence of infant checkups within 1 week of early (< or =48 hours) hospital discharge ranged from 51.5% to 88.6%. Prevalence of postpartum contraceptive use ranged from 77.9% to 89.9%. INTERPRETATION: PRAMS data indicate that 19 states are well below the Healthy People 2010 objective for folic acid consumption, as measured by multivitamin use. Data for infant checkups indicate that guidelines for care are not being followed for as many as half of those discharged early. However, data for additional years are needed to assess trends in these four indicators. PUBLIC HEALTH ACTION: State maternal and child health programs can use these population-based data to monitor progress toward Healthy People 2010 objectives, evaluate adherence to guidelines for care, and assess changes in prevalence of other health behaviors. The data can be shared with policy makers to direct policy decisions that might affect the health of mothers and infants. By providing data on maternal behaviors and experiences that are associated with adverse outcomes, PRAMS supports the activities of two CDC initiatives-to promote safe motherhood and to reduce infant mortality and low birthweight.

Contraception Behavior↗